Get Bcal 4603

The Bcal 4603 form is essential for documenting incidents such as accidents, illnesses, deaths, or fires within licensed facilities in Michigan. This guide will provide you with clear and structured instructions on how to complete this form efficiently online.

Follow the steps to accurately fill out the Bcal 4603 form.

1. Click ‘Get Form’ button to access the Bcal 4603 online document and open it in your preferred editor.
2. Begin by filling out the Facility section, including the License Number, Facility Name, Facility Type, and Address details such as City, State, and Zip Code.
3. Provide information about the Licensing Consultant, including their Name and Phone Number, ensuring that this information is accurate and clearly entered.
4. In the Person(s) in Care Involved section, enter the names, ages, sexes, and addresses of the individuals involved in the incident, indicating if they are minors by providing the name and work phone number of their parent.
5. Complete the Other Person(s) Involved / Witness(es) section by listing names, addresses, and phone numbers of witnesses to the incident.
6. Fill out the Notification section, including names of people notified, notification dates, and times for each person involved.
7. Document the incident details, including Date, Time, Description, Cause, and Surrounding Circumstances, making sure to provide a thorough account of what occurred.
8. If applicable, record information regarding First Aid given, the name of the first aid provider, and any other relevant actions taken.
9. Complete the Physician's Diagnosis section with details of any injuries or illnesses, including the name of the treating physician and their contact information.
10. Make sure to sign the form in the Signature section, providing the date and title of the person completing the report. If required, also include the signature of the registrant or responsible person.
11. Finally, save your changes, then download, print, or share the completed form as necessary.

Complete your documents online today for a streamlined and efficient process.